Mobility performance impacts mortality risk in community-dwelling healthy older adults in Japan: a prospective observational study

Independent and joint associations of skeletal muscle mass and physical performance with all-cause mortality among older adults: a 12-year prospective cohort study

Background

Decreased skeletal muscle mass and low physical performance are independently associated with increased mortality in elderly individuals. However, little is known about the effects of skeletal muscle mass combined with physical performance on the prediction of mortality risk among community-dwelling older adults. This study aimed to determine the combined effects of skeletal muscle mass and physical performance on total mortality.

Methods

A community-based prospective cohort study was conducted among 641 participants aged 65 and older in 2009. The height-adjusted skeletal muscle index (hSMI) and the weight-adjusted SMI (wSMI) were determined by dual-energy X-ray absorptiometry examination. Physical performance tests measured at baseline included gait speed (GS), timed up-and-go (TUG) test, timed chair stand (TCS), weight-adjusted leg press (WaLP), and handgrip strength (HS). Cox proportional hazards regression models were applied to determine the adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (95% CIs) for baseline skeletal muscle mass, physical performance, and traditional risk factors.

Results

During the follow-up of 12 years, 198 (30.89%) participants died. Low hSMI, low GS, high TUG, high TCS, low WaLP, and low HS were associated with high risks of mortality after the adjustment for confounders. The results of receiver operating characteristic (ROC) curve analyses revealed the values of ROC for models with additional consideration for TUG or all indicators significantly improved the discriminatory ability of mortality compared with the model with traditional factors (all P < 0.05). Elders with low hSMI and low GS (HRs = 4.33, 95% CI: 2.76–6.78), high TUG (4.11, 2.60–6.48), high TCS (2.97, 1.92–4.59), low WaLP (3.19, 2.13–4.79), and low HS (4.08, 2.70–6.17) were associated with high risks of mortality compared with those with high hSMI and their corresponding counterparts.

Conclusion

The hSMI and physical performance are significantly associated with increased risks of all-cause mortality. The combined use of hSMI and physical performance can provide improved risk stratification, which may be appropriately used as a screening tool targeting high-risk elders for the effective prevention of sarcopenia-related mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03292-0.

Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study

Background

While there is evidence about stablished risk factors (e.g., raised blood pressure) and higher mortality risk in older population, less has been explored about other functional parameters like the Timed Up and Go test and the Gait Speed in older people at low- and middle-income countries. We aimed to study these mobility tests as predictors of mortality in a population of older people in Peru.

Methods

Population-based prospective cohort study (2013–2020). Random sampling of people aged 60+ years in a community of Lima, Peru. Geriatricians conducted all clinical evaluations and laboratory tests were conducted in the local hospital. Participants were sought in the national vital registration system, and we collated cause (ICD-10) and date of death. We conducted a nested forward multivariate Cox proportional hazard model to identify all potential predictors of all-cause, communicable and non-communicable diseases mortality.

Results

At baseline, there were 501 older people (mean age 70.6 and 62.8% were women), complete follow-up information was available from 427 people. Mean follow-up time was 46.5 months (SD = 25.3). In multivariate models, the Timed Up and Go test was associated with higher risk of all-cause mortality (HR = 1.05; 95% CI: 1.02–1.09). For cause-specific mortality, history of heart disease (HR = 2.25; 95% CI: 1.07–4.76) and age in years (HR = 1.05; 95% CI: 1.01–1.09) were predictors of non-communicable diseases mortality.

Conclusions

In addition to established risk factors for mortality in older population, the Timed Up and Go test, a functional parameter, raised as a relevant predictor of all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02749-6.

Physical and functional measures predicting long-term mortality in community-dwelling older adults: a comparative evaluation in the Singapore Longitudinal Ageing Study

Measures of functional status are known to predict mortality more strongly than traditional disease risk markers in old adult populations. Few studies have compared the predictive accuracy of physical and functional measures for long-term mortality. In this prospective cohort study, community-dwelling older adults (N = 2906) aged 55 + (mean age 66.6 ± 7.7 years) were followed up for mortality outcome up to 9 years (mean 5.8 years). Baseline assessments included Timed Up-and-Go (TUG), gait velocity (GV), knee extension strength, Performance Oriented Mobility Assessment, forced expiratory volume in 1 second, Mini-Mental State Examination (MMSE), Geriatric Depression Scale, frailty, and medical morbidity. A total of 111 (3.8%) participants died during 16976.7 person-years of follow up. TUG was significantly associated with mortality risk (HR = 2.60, 95% CI = 2.05–3.29 per SD increase; HR = 5.05, 95% CI = 3.27–7.80, for TUG score ≥ 9 s). In multivariate analysis, TUG remained significantly associated with mortality (HR = 1.64, 95% CI = 1.20–2.19 per SD increase; HR = 2.66, 95% CI = 1.67–4.23 for TUG score ≥ 9 s). In multivariable analyses, GV, MMSE, Frailty Index (FI) and physical frailty, diabetes and multi-morbidity were also significantly associated with mortality. However, TUG (AUC = 0.737) demonstrated significantly higher discriminatory accuracy than GV (AUC = 0.666, p < 0.001), MMSE (AUC = 0.63, p < 0.001), FI (AUC = 0.62, p < 0.001), physical frailty (AUC = 0.610, p < 0.001), diabetes (AUC = 0.582, p < 0.001) and multi-morbidity (AUC = 0.589, p < 0.001).

TUG’s predictive accuracy shows surpassing predictive accuracy for long-term mortality in community-dwelling older adults.

Impact of physical and functional fitness on mortality from all causes of physically independent older adults

OBJECTIVE

To provide reference values for functional fitness tests (PFFT) and verify the capability of these tests alone and grouped into a general index (GFFI-6), to predict mortality from all causes, during seven years of follow-up of physically independent older adults.

METHODS

The sample consisted of 422 older adults, evaluated at baseline using six PFFTs, as well as sociodemographic, behavioral, anthropometric, and comorbidity variables. Mortality from all causes was followed for seven subsequent years. The sample was subdivided into four groups according to sex and age. Performances in the PFFT and GFFI-6 tests were ranked into "low", "regular", and "high".

RESULTS

Cox proportional regression, with the adjustment of variables, indicated that the Unipedal Balance Test (BAL), Body Agility (AGI), Sit and Stand-up (SIT-SD) tests, and GFFI-6 were able to significantly predict mortality, indicating that older adults with "low" performance have, respectively, a 2.7 (CI=1.54-4.89, p = 0.01), 4.2 (CI=2.10-8.41), 2.5 (CI=1.44-4.65, p = 0.01), and 4.7 (CI=2.10-10.81, p<0.01) times higher risk of death, compared to older adults with "high" performance.

CONCLUSION

BAL, AGI, and SIT-SD tests alone and tests grouped in the GFFI-6 were strong predictors of all-cause mortality in physically independent older adults.